The purpose of the research was to assess the state of time-related indicators of heart rate variability (HRV) under the influence of combined treatment including omega-3 polyunsaturated fatty acids (omega-3 PUFAs) in patients with different forms of atrial fibrillation (AF) and heart failure (HF), depending on the presence of insulin resistance.
Materials and methods. The study involved 73 patients with New York Heart Association (NYHA) Class I and II HF and AF and metabolic syndrome (MS). Paroxysmal form of AF was noted in 18 persons, persistent form of AF was seen in 11 persons, 44 persons were diagnosed with permanent form of AF; 15 patients developed NYHA class I HF, 58 patients developed NYHA class II HF. In addition to basic antiarrhythmic therapy 25 patients received aspirin (ASA) (Group 1), 23 patients were given omega-3 PUFAs (Group 2) and 25 patienst took ASC + L-arginine (Group 3).
The oral glucose-tolerant test (OGTT) with a parallel determination of glucose (oxidase method) and endogenous insulin (EI) (ELISA) in the blood plasma, Holter ECG monitoring (ECG Hm) with assessment of HRV time-related parameters 2 month before and after complex treatment were performed. Control group included 20 practically healthy persons.
Results and discussion. The patients with NYHA class I-II AF and HF and insulin resistance developed violation of temporal parameters of HRV with increased sympathetic nervous system tone in terms of SDANN and decrease in the parasympathetic tone levels according to RMSSD and pNN50 parameters. After treatment the HRV parameters changed positively with varying intensity depending on the type of treatment. Patients with reactive (2 hours after glucose load) and spontaneous (in fasting state) hyperinsulinemia showed a reduction in heart rate (HR) by 16.88% (group 1), 23.88% (group 2) and 17.90% (group 3), respectively compared to basal levels (p1 <0.05). Sinus rhythm was restored in 5 (27.77%) patients with paroxysmal AF. Paroxysmal form of AF transformed into persistent AF in 13(72.22%) patients. In patients with persistent and permanent forms normosystolic variant of AF was reached. In patients with NYHA class I heart failure HR did not change significantly (p1<0.1), in patients with NYHA class II HF it declined by almost 20% in groups 2 and 3 (p1<0.05). In patients with hyperinsulinemia RMSSD index tended to increase in group 1 (p1 <0.1), increased by 24.29% and 22.91% in groups 2 and 3, respectively (p1<0.05), in patients with NYHA class II HF it increased by 1.5 times compared to basal levels (p1<0.05). A similar direction and intensity changes were detected for the pNN50 parameter.
The SDNN index decreased in 8 (44.44%) patients with paroxysmal atrial fibrillation (p1<0.05). The SDANN index decreased by 17.21% in 24 (43.63%) patients with persistent and permanent AF (p1<0.05). 31 (56.36%) patients had a tendency to decrease this index compared to the basal level and index in patients belonged to group 1 (p1<0.1, p2<0.1). The time domain parameters SDNN and SDNN index didn’t significantly change compared to basal levels in all the patients (p1<0.1).
Conclusions. Violations of temporal parameters of HRV with increased sympathetic nervous system tone in terms of SDANN and decreased parasympathetic nervous system tone level according to RMSSD and pNN50 parameters were noted in patients with AF and insulin resistance. Under the influence of treatment the balance between the units of the autonomic nervous system (ANS) was restored. The increased parasympathetic activity according to RMSSD and pNN50 parameters and reduction of sympathetic activity in terms of SDANN were detected. The effectiveness of treatment including omega-3 PUFAs for patients with AF and insulin resistance was higher compared to monotherapy ASA and ASA + L-arginine.
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